Healthcare Provider Details

I. General information

NPI: 1295130300
Provider Name (Legal Business Name): WELL AGAIN MHT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2014
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 N LEE AVE SUITE 310
OKLAHOMA CITY OK
73103-2600
US

IV. Provider business mailing address

1575 HERITAGE DR SUITE 200
MCKINNEY TX
75069-3288
US

V. Phone/Fax

Practice location:
  • Phone: 405-272-7452
  • Fax:
Mailing address:
  • Phone: 844-493-5087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT RADER
Title or Position: OWNER / PRESIDENT
Credential: M.D.
Phone: 972-616-4932